Smudgy Liver

For those who are used to the direct portography this image of the liver may seem a bit messy.

Looking closely one can see the portal phase superimposing on the venous phase in the absence of the usually intervening parenchymal phase.

In fact in this patient with hereditary hemorrhagic telangiectasia (rendu-Osler-Weber) blood whisks through the liver by numerous portovenous shunts.